BACKGROUND AND PURPOSE:

• Evidence regarding prostaglandin use (e.g., misoprostol or dinoprostone) for pain relief in the setting of office hysteroscopy is conflicting
  • Lack of consistency may be due to different dosing intervals
• Rund et al. (Journal of Minimally Invasive Gynecology, 2021) sought to determine the optimal timing of vaginal dinoprostone administration before office hysteroscopy in nulliparous women

METHODS:

• Randomized, double-blinded trial
• Participants
  • Nulliparous
  • Undergoing office hysteroscopy
• Interventions
  • Long interval dinoprostone
    • 3 mg administered vaginally 12 hours before hysteroscopy
  • Short interval dinoprostone
    • 3 mg administered vaginally 3 hours before hysteroscopy
• Primary outcome
  • Pain during hysteroscopy: Measured on 100-mm visual analog scale (0=no pain; 100=worst pain imaginable)
• Secondary outcomes
  • Ease of hysteroscope passage
  • Patient satisfaction score
  • Drug side effects

RESULTS:

• Long interval: 90 women | short interval: 90 women
• Long-interval dinoprostone had lower pain scores during hysteroscopy (P<0.001)
  • Long: mean (SD) pain score 36.2 (8.1)
  • Short: 51.9 (10.5)
  • Mean difference -15.7 (95% CI, -18.4 to 12.9)
• Pain scores 30 minutes post-procedure were similar in both groups (P=0.1)
  • Long: 28.1 (9.0)
  • Short: 31.3 (18.1)
  • Mean difference -3.2 (95% CI, -7.4 to 1.0)
• Long interval dinoprostone was associated with
  • Greater patient satisfaction (P<0.001)
  • Easier hysteroscope passage through cervical canal (P=0.003)
  • Shorter procedure duration (P<0.001)
• Side effects were comparable in both groups

CONCLUSION:

• Vaginal dinoprostone administration to nulliparous patients 12 hours vs 3 hours prior to office hysteroscopy reduced pain and was also associated with higher patient satisfaction, easier hysteroscope insertion, and shorter procedure duration
• The authors suggest that while this RCT proves “the time-dependent efficacy of vaginal dinoprostone administration for relieving pain in nulliparous women” undergoing office hysteroscopy, they also advise        

Future studies should also compare dinoprostone timings in other study populations such as postmenopausal women and include comparative placebo groups to the active study groups

Learn More – Primary Sources:

Determining the Optimal Time Interval Between Vaginal Dinoprostone Administration and Diagnostic Office Hysteroscopy in Nulliparous Women: A Randomized Double-Blind Trial

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Pain Control During In-Office Hysteroscopy: Nitrous Oxide vs Lidocaine vs No Analgesic

Reducing Pain During Office Hysteroscopy: Voltaren vs Buscopan

Reducing Hysteroscopy Pain with Transcutaneous Nerve Stimulation